First evidence on a general disease ("d") factor underlying psychopathology and physical illness in adolescents.

The coexistence of mental and physical health illnesses could be accounted for by an underlying general disease factor (termed d-factor), reflecting theoretical underpinnings based on possible genetic and pathophysiological overlapping mechanisms. This study evaluated whether the d-factor underlies mental and physical health illnesses in adolescents. A series of confirmatory factor analyses were conducted using data from 1120 adolescents. The proposed common underlying factor, we believe is the d-factor, was consistently present across different modeling approaches, including unidimensional, correlated-factor, and bifactor models. The best model fit was achieved with the bifactor model represented by mental, neurological, and psychical conditions tested. The first compelling evidence was provided supporting the existence of the transdiagnostic d-factor in youth, opening the door to innovative research of comorbid mental and physical health conditions.

Known-groups and convergent validity of the theory of mind task battery in children with autism spectrum disorder.

OBJECTIVES: One of the most promising Theory of Mind (ToM) tests developed for children with ASD is the Theory of Mind Task Battery (ToM-TB). Still, additional psychometric properties of this tool need to be assessed. The main objective of this preregistered study was to investigate the known-groups and convergent validities of the ToM-TB compared to a well-established test used to assess ToM in children with ASD (the Strange Stories Test; SST). METHODS: A total of 68 school-aged children were recruited (34 children with ASD and 34 children with typical development). The groups were matched on sex and age, and on both receptive language abilities and overall cognitive functioning. RESULTS: Regarding the known-groups validity, we found group differences in the performance on the ToM-TB and SST. Additional analyses revealed that this result tended to be more robust for the ToM-TB than for the SST. Regarding convergent validity, we showed that the ToM-TB and SST correlated strongly, for children with ASD and children with typical development. In contrast, we found small correlations of these two tests with social competence in daily life. No evidence was found for greater known-groups or convergent validity of one test compared to the other. CONCLUSION: Our data confirmed the relevance of the ToM-TB and the SST for the assessment of ToM in school-aged children. Future studies should continue to assess the psychometric qualities of various ToM tests to provide reliable information to best guide researchers and clinicians when choosing optimal neuropsychological tools.

ASD with ADHD vs. ASD and ADHD alone: a study of the QbTest performance and single-dose methylphenidate responding in children and adolescents.

BACKGROUND: The continuous performance task (CPT) may help identify coexistent attention deficit hyperactivity disorder (ADHD) in autism spectrum disorder (ASD). The Quantified behavior Test (QbTest) combines a CPT and motion-tracking data to assess ADHD symptoms. This study aimed to evaluate the QbTest performance of children and adolescents with ASD plus ADHD, including estimating the effects of single-dose methylphenidate (MPH). To achieve these aims, (1) the QbTest performances were evaluated in ASD alone, ASD plus ADHD, and ADHD alone, and (2) the effects on the QbTest performance of single-dose MPH before and after intake were estimated across the groups. It was assumed that the ASD plus ADHD performance, including the MPH response, would preferably resemble the performance in ADHD alone, rather than ASD alone. METHODS: Retrospective data were analyzed for 482 children and adolescents: 69 with ASD alone, 142 with ASD plus ADHD (ASD/ADHD), and 271 with ADHD alone. For 343 subjects, the QbTest was performed before and up to four hours after a single-dose MPH intake. A summary index of the CPT and motion-capture data was provided for QbTest cardinal parameters. RESULTS: Of 12 QbTest parameters assessed before given MPH, the ASD/ADHD group had scores in line with the ASD group regarding four parameters and the ADHD group regarding nine parameters. Significant differences between groups were seen with respect to QbInattention (p > 0.05); the lowest scores in ASD and the highest in ADHD. Those with ASD/ADHD and ADHD had similar QbActivity and QbImpulsivity scores, but significantly higher than those with ASD. After MPH intake, scores for QbActivity decreased similarly in ASD/ADHD and ADHD, as well as scores for QbImpulsivity. QbImpulsivity increased in ASD. QbInattention scores decreased similarly in all groups after MPH intake. CONCLUSIONS: Children and adolescents with ASD plus ADHD exhibited more atypical QbTest performances than those with ASD alone, while most of their performances were similar to those observed in ADHD alone. In addition, a single dose of MPH mitigated attention deficits and decreased hyperactivity while improved impulsivity in these children. Prospective studies should further clarify the role of the QbTest in the diagnostic and therapeutic interventions in ASD with ADHD.

Pandemic-related emergency psychiatric presentations for self-harm of children and adolescents in 10 countries (PREP-kids): a retrospective international cohort study.

To examine the differences in hospital emergency psychiatric presentations for self-harm of children and adolescents during the covid-19 lockdown in March and April 2020 compared with the same period in 2019. Retrospective cohort study. We used electronic patient records from 23 hospital emergency departments in ten countries grouped into 14 areas. We examined data on 2073 acute hospital presentations by 1795 unique children and adolescents through age 18. We examined the total number of emergency psychiatric hospital presentations and the proportion of children and adolescents presenting with severe self-harm as our two main outcome measures. In addition, we examined sociodemographic and clinical characteristics and clinical management variables for those presenting with self-harm. To compare the number of hospital presentations between 2020 and 2019 a negative binomial model was used. For other variables, individual participant data (IPD) meta-analyses were carried out. Emergency psychiatric hospital presentations decreased from 1239 in 2019 to 834 in 2020, incident rate ratio 0.67, 95% CI 0.62-0.73; p < 0.001. The proportion of children and adolescents presenting with self-harm increased from 50% in 2019 to 57% in 2020, odds ratio 1.33, 1.07-1.64; p = 0.009 but there was no difference in the proportion presenting with severe self-harm. Within the subpopulation presenting with self-harm the proportion of children and adolescents presenting with emotional disorders increased from 58 to 66%, odds ratio 1.58, 1.06-2.36; p = 0.025. The proportion of children and adolescents admitted to an observation ward also decreased from 13 to 9% in 2020, odds ratio 0.52, 0.28-0.96; p = 0.036. Service planners should consider that, during a lockdown, there are likely to be fewer emergency psychiatric presentations. Many children and adolescents with psychiatric emergencies might not receive any service. A focus on developing intensive community care services with outreach capabilities should be prioritised.

COVID-19 pandemic-related aspects and predictors of emotional and behavioural symptoms in youth with pre-existing mental health conditions: results from Georgia, Lithuania, Romania, Serbia, and Turkey.

OBJECTIVE: This study evaluated levels of and predictors of emotional and behavioral symptoms in youth with pre-existing mental health conditions over the early phase of the COVID-19 pandemic in 2020 across Georgia, Lithuania, Romania, Serbia, and Turkey. METHODS: The study included 421 children and adolescents aged 5 - 18 years with pre-existing mental health conditions and corresponding ongoing treatments. We used a parent- and/or child-report, which taps into a broad range of mental health symptoms and contextual factors thought to be particularly pertinent during periods of social restrictions. Data were collected simultaneously across the countries from May 2020 to August 2020. RESULTS: According to parents, 121 (33.1%) children had deteriorations in the overall quality of mental health over the COVID-19, 156 (43.1%) deteriorations in the quantity of mental health care received, while 82 (25.1%) mental health care received did not meet the needs. For 121 (49.8%) of children, there was worsening in the main presenting psychiatric symptom compared to January 2020, while for 64 (26.3%) there was some improvement. In total, 128 (43.9%) children reported worsened emotional and 118 (40.6%) behavioral symptoms. The COVID-related worry, parental emotional difficulties, and parent-child relationships emerged as the most relevant predictors for higher levels of emotional and behavioral difficulties. CONCLUSIONS: This study found that the COVID-19 pandemic has considerably changed the daily lives of some children with pre-existing mental health conditions, where almost every second child had deteriorations in overall mental health or worsening of psychiatric symptoms.

DIFFERENCE IN PREDICTORS OF ANASTOMOTIC LEAKAGE DEPENDING ON THE LEVEL OF ANASTOMOSIS AFTER COLORECTAL CANCER SURGERY.

Anastomotic leak (AL) after colorectal cancer surgery is one of the most serious postoperative complications which has major impact on outcomes. The aim of this study was to investigate preoperative and intraoperative risk factors for AL, as well as to examine whether there are differences in risk factors for AL depending on the primary tumor location. We retrospectively reviewed records of patients having undergone colorectal surgical procedures for malignancies between January 2013 and December 2017 in a single institution. Only procedures with primary anastomosis were included. Of the 153 patients, AL occurred in 10.6% of patients with primary tumor in the sigmoid colon and rectum, and in 8.2% of patients with primary tumor in the proximal sections of the colon. On univariate analysis, delayed oral intake and more advanced histologic stages of the tumor were significantly correlated with AL in patients with tumors in the sigmoid colon and rectum, and multiorgan resection and distant metastases in patients with tumors in the proximal sections of the colon. In conclusion, risk factors for the occurrence of AL vary depending on the primary tumor location and further investigation is needed to provide better insight into these differences.

Changes in cognitive distortions and affectivity levels in adolescent depression after acute phase fluoxetine treatment.

INTRODUCTION: It is supposed that both antidepressants and psychotherapies work in a manner consistent with cognitive theories of depression when changing negative affective and cognitive distortions. This study evaluated changes in cognitive distortions (i.e. systematic misinterpretations of new information) and affectivity in adolescent major depressive disorder (MDD) after acute phase treatment with fluoxetine. METHODS: Twenty-five adolescents (mean age 15.10 years (SD = 1.19); 17 (68%) females) with MDD receiving fluoxetine were followed for 8 weeks. Clinician rating scales of MDD and self-reports of cognitive distortions and affectivity were completed before and after the treatment. RESULTS: Seven (28%) adolescents showed significant improvement in cognitive distortions, 11 (44%) showed a significant decrease in negative affect, and 15 (60%) showed a significant increase in positive affect. The responders to fluoxetine had significantly decreased level of negative affect (62.5%) and an increased level in positive affect (81.2%) compared to non-responders, whereas there were no differences between the two regarding changes in cognitive distortions. CONCLUSIONS: Treatment with fluoxetine over 8 weeks led to reductions in cognitive distortions, with decreased negative and increased positive affect in adolescents with MDD. Improvements in affectivity levels closely corresponded to reductions in depressive symptoms and were greater than improvements in cognitive distortions.

Health-related quality of life questionnaire for polycystic ovary syndrome (PCOSQ-50): a psychometric study with the Serbian version.

This study aimed to analyze the measurement properties of the Health-related quality of life questionnaire for polycystic ovary syndrome (PCOSQ-50) in a sample of Serbian women with polycystic ovary syndrome (PCOS). Seventy-six women with PCOS from an endocrinology clinic and 28 healthy women participated between October 2016 and March 2017. The measure was rigorously translated and culturally adapted into Serbian. Psychometric evaluation included descriptive analysis, internal consistency (Cronbach's alpha coefficient), test-retest reliability (intraclass-correlation coefficient - ICC) and construct validity testing. Cronbach's alpha coefficient ranged from 0.67 to 0.96 for domain scales of PCOSQ-50 scores, while the ICCs for test-retest reliability for these domains ranged from 0.66 to 0.89. Women with PCOS had significantly lower scores than healthy women for hirsutism, obesity and menstrual disorders and the total PCOSQ-50 scale score (p ≤ 0.03), but not for the psychosocial and emotional, fertility, sexual function, and coping scales. These results show that the Serbian PCOSQ-50 measure is acceptable and could produce reliable and valid assessments of PCOS-related quality of life for at least four out of seven domains. Considering that validity testing is an iterative process, additional work is needed before the whole measure is used in routine clinical practice.

Relationship between obesity and health-related quality of life in children aged 7-8 years.

BACKGROUND: The dramatic increase in the prevalence of obesity in developed and developing countries has become a major health care concern. Accordingly, there is growing recognition of the relationship between health-related quality of life (HRQOL) and obesity in the pediatric population. This study aimed to explore the relationship between HRQOL and different indicators of obesity in children aged 7-8 years. METHOD: In total, 182 children participated in this study (mean age 7.71 (0.29) years, 48.91% girls). To assess obesity, an InBody 230 analyzer was used to calculate body mass index (BMI) and body fat percentage (BFP). The proxy version of the KIDSCREEN-27 questionnaire was used to assess HRQOL. RESULTS: Among boys, 17.2% were overweight and 4.3% were obese according to BMI, while in terms of body fat percentage (BFP), the corresponding percentages were 12.9 and 9.7%, respectively. Among girls, the prevalence of overweight and obesity was 11.2 and 9.0% by BMI and 10.1 and 7.9% in terms of BFP, respectively. The analysis of BFP showed a significantly higher score in normal weight boys than in obese boys in the Social Support & Peers domains (KW H-test = 10.472, p = 0.03), while in girls, there were no significant differences between weight categories and any HRQOL dimensions. CONCLUSION: Obesity at 7-8 years of age could negatively affect some HRQOL domains; in particular, obese boys may have low social support and peer functioning.

The Serbian version of the Juvenile Arthritis Multidimensional Assessment Report (JAMAR).

The Juvenile Arthritis Multidimensional Assessment Report (JAMAR) is a new parent/patient-reported outcome measure that enables a thorough assessment of the disease status in children with juvenile idiopathic arthritis (JIA). We report the results of the cross-cultural adaptation and validation of the parent and patient versions of the JAMAR in the Serbian language. The reading comprehension of the questionnaire was tested in 10 JIA parents and patients. Each participating centre was asked to collect demographic, clinical data and the JAMAR in 100 consecutive JIA patients or all consecutive patients seen in a 6-month period and to administer the JAMAR to 100 healthy children and their parents. The statistical validation phase explored descriptive statistics and the psychometric issues of the JAMAR: the three Likert assumptions, floor/ceiling effects, internal consistency, Cronbach's alpha, interscale correlations, test-retest reliability, and construct validity (convergent and discriminant validity). A total of 248 JIA patients (5.2% systemic, 44.3% oligoarticular, 23.8% RF-negative polyarthritis, 26.7% other categories) and 100 healthy children were enrolled in three centres. The JAMAR components discriminated healthy subjects from JIA patients. All JAMAR components revealed good psychometric performances. In conclusion, the Serbian version of the JAMAR is a valid tool for the assessment of children with JIA and is suitable for use both in routine clinical practice and clinical research.

Clinical significance of neoangiogenesis and index of proliferation in the signet ring type of gastric adenocarcinoma.

PURPOSE: The purpose of this study was to examine whether microvascular density and the level of proliferation in gastric signet ring cell carcinoma (SRCC) are important factors in the locoregional control of the disease. METHODS: Over a period of eight years, gastric resection specimens from 37 patients were examined. The proliferative index (labelled by Ki67) and microvascular density (MVD) index (mvdIDX) (labelled by CD105) were determined for each case of SRCC. RESULTS: Gastric SRCC was diagnosed more often in female than in male patients (21 females, 16 males ; p≤0.05) . The average age of female patients was 63 years, while the male patients were 62 years old on average (p=0.702). Immunohistochemical analysis showed that the median numbers of Ki67 positive cells and CD105 positive blood vessels were higher in tumors compared to surrounding non-tumor tissue. Higher proliferative index and higher mvdIDX were also established relative to tumor stage. Correlation analysis showed a high positive correlation between proliferation index and microvascular density (MVD) index (mvdIDX) (correlation coefficient=0.784). Receiver operating characteristics (ROC) analysis showed progression of both indices examined. CONCLUSION: Our results showed that, although both proliferative and mvdIDXs are reliable, the former had better performance in identifying of disease progression (AUC=0.970).

Cross-Cultural Measurement Invariance of Adolescent Self-Report on the Pediatric Quality of Life Inventory™ 4.0.

This study evaluated the cross-cultural measurement invariance of the Pediatric Quality of Life Inventory version 4.0 (PedsQL™) among adolescents sampled from Bulgaria, Croatia, India, Indonesia, Nigeria, Serbia, and Turkey. The multiple-indicator multiple-cause (MIMIC) model was used, which allowed controlling of demographic variables (i.e., age, gender, and socioeconomic status). Significant effects of country on scores within the PedsQL™ domains were observed, with up to 17 items showing differential item functioning (DIF) across the countries. We did not find support for cross-cultural measurement invariance hypotheses for scores on the PedsQL™ adolescent self-report in this study. Researchers should use caution in making cross-cultural quality of life comparisons while using the PedsQL.

Cross-cultural Measurement Equivalence of the KINDL Questionnaire for Quality of Life Assessment in Children and Adolescents.

This cross-cultural study aimed to assess whether Iranian and Serbian children, and also their parents, perceived the meaning of the items in the KINDL quality of life questionnaire consistently. The sample included 1086 Iranian and 756 Serbian children and adolescents, alongside 1061 and 618 of their parents, respectively. The ordinal logistic regression was used to assess differential item functioning (DIF) of the self and proxy-reports of the two versions of the KINDL, including Kid-KINDL and Kiddo-KINDL, across Iranian and Serbian samples. Statistically significant DIF was flagged for 14 out of 24 (58%) and 20 out of 24 (83%) items in the self-report of the Kid-KINDL and Kiddo-KINDL, respectively. Moreover, 20 out of 24 (83%) in the proxy reports of the both Kid-KINDL and Kiddo-KINDL, showed DIF across two samples. Accordingly, considerable caution is warranted when using the KINDL for cross-cultural comparisons.

Improved quality of life in hyperthyroidism patients after surgery.

BACKGROUND: The most common causes of hyperthyroidism are Graves disease (GD) and toxic nodular goiter (TNG). GD and TNG might influence patients' quality of life (QoL). The aim of our study was to analyze and compare the QoL of patients with GD with that of TNG patients and to evaluate the influence of surgical treatment on their QoL. MATERIALS AND METHODS: A prospective case-control study was conducted at the Center for Endocrine surgery in Belgrade, Serbia. The ThyPRO questionnaire was used in the QoL assessment of the GD and TNG patients (31 and 28, respectively) pre- and post-operatively. RESULTS: All patients were receiving antithyroid drugs, and none of the patients were overtly hyperthyroid at the time of completing the preoperative questionnaire. The QoL of the GD patients was worse than that of the TNG patients, with significant differences in eye symptoms, anxiety, and sex life domains (P < 0.001, P = 0.005, and P = 0.004, respectively), preoperatively, and in eye symptoms, anxiety, emotional susceptibility, and overall QoL (P = 0.001, P = 0.027, P = 0.005 and P = 0.013, respectively), postoperatively. The improvement in QoL in the GD patients was significant after surgical treatment in all ThyPRO domains. In the TNG patients, the improvement was significant in all but one ThyPRO domain, sex life (P = 0.066). CONCLUSIONS: The QoL of GD patients is worse than those of TNG patients. Surgery may improve QoL in patients with GD and TNG even if they have achieved satisfying thyroid status with medication treatment, preoperatively.

A cross-cultural study to assess measurement invariance of the KIDSCREEN-27 questionnaire across Serbian and Iranian children and adolescents.

PURPOSE: The KIDSCREEN questionnaire for health-related quality of life (HRQOL) assessments in children and adolescents was simultaneously developed across 13 European countries, and it was subsequently translated and culturally adapted to over 30 different languages across the world. The aim of this study was to evaluate the measurement equivalence of the KIDSCREEN-27 across Serbian and Iranian children and adolescents. METHODS: The items in the KIDSCREEN-27 were analyzed for differential item functioning (DIF) across Iranian and Serbian populations using ordinal logistic regression with three different criteria. The sample included 330 Iranian and 329 Serbian children and adolescents and 330 and 314 of their parents, respectively. RESULTS: Across the two samples, DIF was detected in 16 (59 %) of 27 items in the child self-reports and in 20 (74 %) of 27 items in the parent/proxy report. However, using alternative criteria based on magnitude detected for DIF, only three items in the parent/proxy report showed significant DIF. CONCLUSION: Our study provided more evidence that the KIDSCREEN-27 possesses DIF items across different cultures, but their impact is probably small, and the questionnaire could be used for cross-cultural HRQOL comparisons.

Adverse effects of antiepileptic drugs and quality of life in pediatric epilepsy.

BACKGROUND: In pediatric epilepsy, health-related quality of life (HRQOL) may be affected across the physical, psychological, social, and school domains. Studies have shown that antiepileptic drugs (AEDs) could have a significant negative impact on HRQOL, but these findings are scarce and inconsistent. AIM: To evaluate the influence that the adverse effects of AEDs have on HRQOL in pediatric epilepsy. MATERIALS AND METHODS: A total of 75 children with epilepsy and at least one parent participated in this study. The Pediatric Quality of Life Inventory (PedsQL) was utilized to assess the HRQOL, while the Adverse Event Profile (AEP) was used to assess the presence and severity of the adverse effects of AEDs. RESULTS: Assessing the children's ratings, the AEP score significantly influenced the PedsQL based psychosocial functioning score (P < 0.02; partial ç2 = 0.07); and, assessing the parents' ratings, the AEP score significantly influenced both the PedsQL based physical functioning score (P < 0.02; partial ç2 = 0.07) as well as the PedsQL psychosocial functioning score (P < 0.001, partial ç2 = 0.30). CONCLUSION: The frequency and severity of AED-related adverse effects could significantly predict the lowered levels of HRQOL among children with epilepsy, in particular having a large impact on their psychosocial functioning.

Are antidepressants effective in quality of life improvement among children and adolescents? A systematic review.

There is some evidence indicating that psychotropic medications might lead to health-related quality of life (QOL) improvements among children and adolescents with psychiatric disorders. The aim of this systematic review is to assess evidence regarding whether antidepressant treatment improves QOL among children and adolescents with depressive or anxiety disorders. A comprehensive search resulted in 5 clinical trials to be included in this review: 4 trials with major depressive disorder (MDD) and 1 trial with social anxiety disorder (SAD). In one MDD trial, fluoxetine combined with cognitive behavior therapy (CBT) significantly improved QOL compared to fluoxetine or CBT alone (effect sizes were 0.53 and 0.69, respectively). In 2 combined trials, sertraline alone significantly improved QOL among adolescents with MDD (effect size was 0.29), but not among children with MDD. Essentially, it was observed that antidepressants in these trials had minor positive effects on QOL improvement, which were lower than their potential to improve depressive symptoms. Although fluoxetine with CBT or sertraline monotherapy were shown to have some potential to improve QOL, this systematic review found inconclusive evidence that antidepressant treatments improve QOL among children and adolescents with depressive or anxiety disorders. More research is required, considering that QOL is currently under-evaluated in clinical trials with antidepressants among children and adolescents and available trials have limited methodological quality when reporting QOL data.

Psychopharmacology in children and adolescents: unmet needs and opportunities.

Psychopharmacological treatment is an important component of the multimodal intervention approach to treating mental health conditions in children and adolescents. Currently, there are many unmet needs but also opportunities, alongside possible risks to consider, regarding the pharmacological treatment of mental health conditions in children and adolescents. In this Position Paper, we highlight and address these unmet needs and opportunities, including the perspectives of clinicians and researchers from the European College of Neuropsychopharmacology-Child and Adolescent Network, alongside those of experts by lived experience from national and international associations, via a survey involving 644 participants from 13 countries, and of regulators, through representation from the European Medicines Agency. We present and discuss the evidence base for medications currently used for mental disorders in children and adolescents, medications in the pipeline, opportunities in the development of novel medications, crucial priorities for the conduct of future clinical studies, challenges and opportunities in terms of the regulatory and legislative framework, and innovations in the way research is conducted, reported, and promoted.

Impact of emotional and behavioral symptoms on quality of life in children and adolescents.

PURPOSE: To evaluate how levels of anxiety, depressive and behavioral symptoms influence self-perceived quality of life (QOL) in general population of children and adolescents. METHOD: A total of 237 children and adolescents aged 8-18 years participated in the study. The Screen for Child Anxiety Related Emotional Disorders Questionnaire (SCARED), Short Mood and Feeling Questionnaire (SMFQ) and Strengths and Difficulties Questionnaire (SDQ) were used to assess levels of anxiety, depressive and behavioral symptoms, respectively. The Pediatric Quality of Life Inventory (PedsQL) was used for QOL assessments. In a regression model, the PedsQL score was the dependent variable, while anxiety, depressive and behavioral symptoms were the QOL predictors. RESULTS: In children, the SCARED and SMFQ scores together with age and gender explained 30 % of the variance in the PedsQL scores (F = 12.31, p < 0.001), while in adolescents, the same set of variables was responsible for 36 % of the variance (F = 15.77, p < 0.001). The SCARED was a more significant predictor than the SMFQ. The SDQ scores did not emerge as the PedsQL predictors. CONCLUSION: Levels of anxiety and depressive symptoms, but not behavioral ones, significantly affect self-reported QOL in general population of children and adolescents.

Health-related quality of life and emotional problems in juvenile idiopathic arthritis.

PURPOSE: Children with juvenile idiopathic arthritis (JIA) are at an increased risk of developing emotional problems. This study evaluated the associations between levels of depressive and anxiety symptoms and health-related quality of life (HRQOL) in these children. METHODS: Sixty-seven children with JIA, together with one parent, participated. Anxiety symptoms were identified using the Screen for Child Anxiety Related Emotional Disorders Questionnaire (SCARED), while depressive symptoms were identified using the Mood and Feeling Questionnaire (MFQ). The Pediatric Quality of Life Inventory (PedsQL) was used for HRQOL assessments. Using hierarchical multiple-regression analysis, demographics, clinical factors, and pain were control variables, while anxiety (the SCARED score) and depressive symptoms (the MFQ score) were HRQOL (the PedsQL score) predictors. RESULTS: The regression model emerged with specified variables explaining 63 % of the variance in the PedsQL score (F = 11.92, p < 0.01) among children. Among parents, the same set of variables accounted for 49 % the variance (F = 6.99, p < 0.01). The MFQ score, but not the SCARED, added most to the variance. CONCLUSIONS: Depressive symptoms, but not anxiety, accounted for substantial variability in levels of HRQOL when considered with demographics, clinical factors, and pain. Thus, screening for depression needs to be considered as a part of multimodal assessment and treatment approaches in JIA.